Provider Demographics
NPI:1881756765
Name:HRISSIKOPOULOS, PAUL (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:HRISSIKOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 WHEATON WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4300
Mailing Address - Country:US
Mailing Address - Phone:360-479-0809
Mailing Address - Fax:360-377-3577
Practice Address - Street 1:2025 WHEATON WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4300
Practice Address - Country:US
Practice Address - Phone:360-479-0809
Practice Address - Fax:360-377-3577
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020630207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1030105Medicaid
WA192575000OtherOWCP
WA911577098OtherUNIFORM MEDICAL PLAN
WAHR8307OtherREGENCE
WA38300OtherLABOR AND INDUSTRIES
WA911577098OtherPREMERA BLUE CROSS
WA911577098-02OtherKITSAP PHYSICIANS SERVICE
WA013194010OtherGROUP HEALTH COOPERATIVE
000200675Medicare ID - Type Unspecified
WA1030105Medicaid